{"id":3115,"date":"2017-12-14T14:42:08","date_gmt":"2017-12-14T13:42:08","guid":{"rendered":"https:\/\/www.czech-neuro.cz\/?page_id=3115"},"modified":"2017-12-14T15:43:03","modified_gmt":"2017-12-14T14:43:03","slug":"sonography","status":"publish","type":"page","link":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/","title":{"rendered":"Transcranial Doppler sonography"},"content":{"rendered":"<h1>Transkrani\u00e1ln\u00ed dopplerovsk\u00e1 sonografie \u2013 n\u00e1rodn\u00ed standard vy\u0161et\u0159en\u00ed v\u00a0r\u00e1mci funk\u010dn\u00ed specializace v&nbsp;neurosonologii<\/h1>\n<p>\u0160koda O., Mikul\u00edk R.., \u0160koloud\u00edk D. Neurosonologick\u00e1 komise cerebrovaskul\u00e1rn\u00ed sekce \u010cesk\u00e9 neurologick\u00e9 spole\u010dnosti J.E.P.<\/p>\n<p><em>\u00a0<\/em><strong><span style=\"text-decoration: underline;\">1. Definice<\/span><\/strong><\/p>\n<p>Transkrani\u00e1ln\u00ed dopplerovsk\u00e1 sonografie je neurosonologick\u00e1 vy\u0161et\u0159ovac\u00ed metoda. Jedn\u00e1 se o&nbsp;ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed, kter\u00e9 umo\u017e\u0148uje neinvazivn\u00ed m\u011b\u0159en\u00ed pr\u016ftok\u016f intrakrani\u00e1ln\u00edmi tepnami p\u0159es intaktn\u00ed lebku s\u00a0vyu\u017eit\u00edm dopplerovsk\u00e9ho re\u017eimu zobrazen\u00ed.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">2. Charakteristika a&nbsp;c\u00edl standardu<\/span><\/strong><\/p>\n<p>N\u00e1rodn\u00ed standard definuje v\u011bcn\u00e9 a&nbsp;person\u00e1ln\u00ed p\u0159edpoklady, podm\u00ednky prov\u00e1d\u011bn\u00ed, standardn\u00ed postup a&nbsp;indikaci vy\u0161et\u0159en\u00ed. Kriteria pro hodnocen\u00ed n\u00e1lez\u016f jsou obsahem odborn\u00e9 p\u0159\u00edlohy standardu.<\/p>\n<p>C\u00edlem standardu je sjednocen\u00ed podm\u00ednek prov\u00e1d\u011bn\u00ed a&nbsp;postupu vy\u0161et\u0159en\u00ed na v\u0161ech pracovi\u0161t\u00edch, kter\u00e1 se zab\u00fdvaj\u00ed\u00a0 ultrazvukovou diagnostikou mozkov\u00fdch tepen, v\u00a0z\u00e1jmu zaji\u0161t\u011bn\u00ed p\u0159esnosti a&nbsp;reprodukovatelnosti n\u00e1lez\u016f.<\/p>\n<p>Neurosonologick\u00e1 komise Cerebrovaskul\u00e1rn\u00ed sekce \u010cesk\u00e9 neurologick\u00e9 spole\u010dnosti J.E.P. je p\u0159edkladatelem a&nbsp;garantem standardu.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">3. V\u011bcn\u00e9 podm\u00ednky<\/span><\/strong><\/p>\n<p>Vy\u0161et\u0159en\u00ed je prov\u00e1d\u011bno na p\u0159\u00edstroji ur\u010den\u00e9m k\u00a0transkrani\u00e1ln\u00edmu z\u00e1znamu v\u00a0dopplerovsk\u00e9m re\u017eimu zobrazen\u00ed a&nbsp;opat\u0159en\u00e9m pot\u0159ebn\u00fdmi ultrazvukov\u00fdmi sondami, analyza\u010dn\u00edm za\u0159\u00edzen\u00edm a&nbsp;p\u0159\u00edslu\u0161n\u00fdm softwarov\u00fdm vybaven\u00edm k\u00a0z\u00edsk\u00e1n\u00ed a&nbsp;vyhodnocen\u00ed sign\u00e1lu.<\/p>\n<p><span style=\"text-decoration: underline;\">3.1.\u00a0 Transkrani\u00e1ln\u00ed doppler \u2013 ultrazvukov\u00fd p\u0159\u00edstroj<\/span><\/p>\n<p>TCD p\u0159\u00edstroj mus\u00ed b\u00fdt vybaven za\u0159\u00edzen\u00edm pro vys\u00edl\u00e1n\u00ed a&nbsp;p\u0159\u00edjem ultrazvukov\u00e9ho vln\u011bn\u00ed s\u00a0vysokou pronikavost\u00ed, pracuj\u00edc\u00edm v\u00a0pulsn\u00edm dopplerovsk\u00e9m re\u017eimu (PW). M\u00e1 schopnost zachytit a&nbsp;vyhodnotit dopplerovsk\u00fd posun frekvenc\u00ed, kter\u00fd vznik\u00e1 odrazem ultrazvukov\u00e9ho paprsku od proudu krve prot\u00e9kaj\u00edc\u00ed intrakrani\u00e1ln\u00edmi tepnami\u00a0 p\u0159i&nbsp;insonaci p\u0159es intaktn\u00ed lebku. Pomoc\u00ed spektr\u00e1ln\u00ed anal\u00fdzy mus\u00ed vytv\u00e1\u0159et grafick\u00fd a&nbsp;zvukov\u00fd z\u00e1znam, jeho\u017e vyhodnocen\u00edm lze posuzovat rychlosti toku krve a&nbsp;hemodynamick\u00e9 parametry vy\u0161et\u0159ovan\u00fdch tepen. Umo\u017e\u0148uje identifikaci insonovan\u00fdch tepen pomoc\u00ed \u00fadaj\u016f o&nbsp;sm\u011bru toku krve a&nbsp;hloubce, ze kter\u00e9 je sign\u00e1l sn\u00edm\u00e1n.<\/p>\n<p><span style=\"text-decoration: underline;\">Po\u017eadovan\u00e9 vlastnosti:<\/span><\/p>\n<p>3.1.1.\u00a0Mo\u017enost pou\u017eit\u00ed dopplerovsk\u00fdch nosn\u00fdch frekvenc\u00ed v\u00a0rozsahu 1,0 \u2013 2,5 MHz<\/p>\n<p>3.1.2.\u00a0Fokusace sondy minim\u00e1ln\u011b pro hloubky 40 \u2013 60mm, nebo pohybliv\u00e1, mo\u017enost stanoven\u00ed velikosti vzorkovac\u00edho objemu a&nbsp;jeho um\u00edst\u011bn\u00ed do oblasti z\u00e1jmu<\/p>\n<p>3.1.3.\u00a0Z\u00e1znam dopplerovsk\u00e9ho sign\u00e1lu formou spektr\u00e1ln\u00ed k\u0159ivky (D \u2013 mode), p\u0159\u00edpadn\u011b nav\u00edc formou anal\u00fdzy\u00a0 intenzity sign\u00e1lu v\u00a0hloubkov\u00e9m \u0159ezu, s\u00a0posunem po&nbsp;\u010dasov\u00e9 ose (Power M \u2013 mode)<\/p>\n<p>3.1.4.\u00a0Pro\u00a0zaji\u0161t\u011bn\u00ed specieln\u00edch metodik vy\u0161et\u0159en\u00ed (monitoring\u016f) je vhodn\u00e9 vybaven\u00ed specieln\u00ed sondou s\u00a0fixa\u010dn\u00edm za\u0159\u00edzen\u00edm a&nbsp;specieln\u00ed softwarov\u00fd soubor (pro anal\u00fdzu HITS apod.)<\/p>\n<p>Pozn\u00e1mka: Je-li sonda pro TCD vy\u0161et\u0159en\u00ed sou\u010d\u00e1st\u00ed v\u00edce\u00fa\u010delov\u00e9ho (nej\u010dast\u011bji duplexn\u00edho) ultrazvukov\u00e9ho p\u0159\u00edstroje, mus\u00ed cel\u00fd komplet spl\u0148ovat v\u00fd\u0161e popsan\u00e9 podm\u00ednky. Data TCD z\u00e1znamu mohou b\u00fdt z\u00edsk\u00e1na tak\u00e9 pomoc\u00ed p\u0159\u00edstroje k\u00a0 transkrani\u00e1ln\u00ed barevn\u00e9 duplexn\u00ed sonografii (TCCS), kter\u00fd je vybaven pulsn\u00edm dopplerovsk\u00fdm re\u017eimem a\u00a0vy\u0161et\u0159ovac\u00edmi frekvencemi mezi 2,0 a&nbsp;4,0 MHz. Vzhledem k\u00a0vyu\u017eit\u00ed \u00fahlov\u00e9 korekce u&nbsp;t\u011bchto p\u0159\u00edstroj\u016f v\u0161ak doporu\u010dujeme postupovat p\u0159i&nbsp;hodnocen\u00ed z\u00e1znamu dle norem pro TCCS.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">4. Person\u00e1ln\u00ed vybaven\u00ed<\/span><\/strong><\/p>\n<p>Vy\u0161et\u0159en\u00ed prov\u00e1d\u00ed l\u00e9ka\u0159, kter\u00fd je jedin\u00fdm opr\u00e1vn\u011bn\u00fdm nositelem v\u00fdkonu. Podm\u00ednkou k\u00a0prov\u00e1d\u011bn\u00ed vy\u0161et\u0159en\u00ed je z\u00edsk\u00e1n\u00ed funk\u010dn\u00ed specializace v\u00a0neurosonologii, funk\u010dn\u00ed licence pro metodu TCD dle p\u0159\u00edlohy Stavovsk\u00e9ho p\u0159edpisu \u010d.&nbsp;12 \u010cesk\u00e9 l\u00e9ka\u0159sk\u00e9 komory.<\/p>\n<p>4.1.\u00a0<span style=\"text-decoration: underline;\">P\u0159edpoklady<\/span><\/p>\n<p>P\u0159edpokladem k\u00a0z\u00edsk\u00e1n\u00ed funk\u010dn\u00ed specializace je atestace z\u00a0oboru neurologie, radiologie, ARO nebo za\u0159azen\u00ed do atesta\u010dn\u00ed p\u0159\u00edpravy z&nbsp;neurochirurgie, p\u0159\u00edpadn\u011b spln\u011bn\u00ed podm\u00ednek pro ud\u011blen\u00ed licence z\u00a0t\u011bchto obor\u016f.<\/p>\n<p>4.2.\u00a0<span style=\"text-decoration: underline;\">\u00a0\u00a0\u0160kolen\u00ed a&nbsp;praxe<\/span><\/p>\n<p>Z\u00e1kladn\u00ed kurs TCD v\u00a0d\u00e9lce minim\u00e1ln\u011b 1 t\u00fddne prob\u00edh\u00e1 na \u0161kol\u00edc\u00edm pracovi\u0161ti, stanoven\u00e9m Neurosonologickou komis\u00ed Cerebrovaskul\u00e1rn\u00ed sekce \u010cesk\u00e9 neurologick\u00e9 spole\u010dnosti J.E.P. Podm\u00ednkou je slo\u017een\u00ed zkou\u0161ky, garantovan\u00e9 komis\u00ed.<\/p>\n<p>V\u00a0pr\u016fb\u011bhu prvn\u00edch 5 let je nutno dolo\u017eit nejm\u00e9n\u011b 100 samostatn\u00fdch vy\u0161et\u0159en\u00ed ro\u010dn\u011b, d\u00e1le korelaci n\u00e1lez\u016f TCD s\u00a0referen\u010dn\u00edmi metodikami (angiografie, CTA, MRA) alespo\u0148 ve 25 p\u0159\u00edpadech, v\u010detn\u011b r\u016fzn\u00fdch patologick\u00fdch n\u00e1lez\u016f.<\/p>\n<p>4.3.\u00a0<span style=\"text-decoration: underline;\">Zaji\u0161t\u011bn\u00ed kvality<\/span><\/p>\n<p>K\u00a0zachov\u00e1n\u00ed zku\u0161enosti vy\u0161et\u0159uj\u00edc\u00edho k\u00a0prov\u00e1d\u011bn\u00ed a&nbsp;interpretaci vy\u0161et\u0159en\u00ed je pot\u0159ebn\u00fd dostate\u010dn\u00fd po\u010det vy\u0161et\u0159en\u00ed a&nbsp;pr\u016fb\u011b\u017en\u00e1 kontrola referen\u010dn\u00edmi metodami. Doporu\u010den\u00fd po\u010det TCD vy\u0161et\u0159en\u00ed s\u00a0archivac\u00ed n\u00e1lez\u016f je alespo\u0148 100 ro\u010dn\u011b s\u00a0korelac\u00ed 15 vy\u0161et\u0159en\u00ed s\u00a0referen\u010dn\u00edmi metodami.<\/p>\n<p>Pot\u0159ebn\u00e9 je rovn\u011b\u017e trval\u00e9 vzd\u011bl\u00e1v\u00e1n\u00ed a&nbsp;v\u00fdm\u011bna informac\u00ed s\u00a0ostatn\u00edmi pracovi\u0161ti TCD. Neurosonologick\u00e1 komise garantuje program pr\u016fb\u011b\u017en\u00e9ho vzd\u011bl\u00e1v\u00e1n\u00ed v\u00a0neurosonologii formou odborn\u00fdch semin\u00e1\u0159\u016f a&nbsp;p\u00edsemn\u00fdch publikac\u00ed i&nbsp;v\u00fdm\u011bnu informac\u00ed prost\u0159ednictv\u00edm veden\u00ed datab\u00e1ze neurosonologick\u00fdch pracovi\u0161\u0165.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">5. Technick\u00e9 proveden\u00ed a&nbsp;standardn\u00ed postup vy\u0161et\u0159en\u00ed<\/span><\/strong><span style=\"background-color: #ffffff;\">\u00a0\u00a0<\/span><\/p>\n<p>C\u00edlem TCD vy\u0161et\u0159en\u00ed je zji\u0161t\u011bn\u00ed stavu intrakrani\u00e1ln\u00edch tepen a&nbsp;anal\u00fdza hemodynamick\u00fdch pom\u011br\u016f v\u00a0c\u00e9vn\u00edm syst\u00e9mu mozku.\u00a0 K\u00a0tomuto \u00fa\u010delu je nezbytn\u00e9 spr\u00e1vn\u00e9 technick\u00e9 proveden\u00ed a&nbsp;dodr\u017een\u00ed standardn\u00edho postupu vy\u0161et\u0159en\u00ed.<\/p>\n<p>5.1.\u00a0<span style=\"text-decoration: underline;\">Technick\u00e9 proveden\u00ed TCD<\/span><\/p>\n<p>V\u00a0pr\u016fb\u011bhu vy\u0161et\u0159en\u00ed TCD je nutno z\u00edskat kvalitn\u00ed dopplerovsk\u00e9 spektr\u00e1ln\u00ed k\u0159ivky (p\u0159\u00edpadn\u011b nav\u00edc z\u00e1znam Power M \u2013 mode) ze v\u0161ech vy\u0161et\u0159ovan\u00fdch tepen. Akustick\u00fd p\u0159\u00edstup k\u00a0t\u011bmto tepn\u00e1m p\u0159edstavuj\u00ed anatomick\u00e1 okna (p\u0159irozen\u00e1 zeslaben\u00ed lebe\u010dn\u00edch kost\u00ed). Ultrazvukov\u00e1 expozice pacienta m\u00e1 b\u00fdt omezena na nezbytn\u00e9 minimum z\u00a0hlediska \u010dasu i&nbsp;akustick\u00e9ho v\u00fdkonu sondy (nezbytn\u00e9 je sn\u00ed\u017een\u00ed akustick\u00e9ho v\u00fdkonu p\u0159i&nbsp;vy\u0161et\u0159en\u00ed p\u0159es orbitu, kter\u00e9 mus\u00ed b\u00fdt zaznamen\u00e1no v\u00a0protokolu vy\u0161et\u0159en\u00ed). Kvalita zobrazen\u00ed je limitov\u00e1na vlastnostmi anatomick\u00fdch oken individu\u00e1ln\u00edho pacienta, ke zlep\u0161en\u00ed kvality sign\u00e1lu je mo\u017eno prov\u00e9st aplikaci pulmostabiln\u00ed kontrastn\u00ed l\u00e1tky p\u0159i&nbsp;TCD vy\u0161et\u0159en\u00ed.<\/p>\n<p>5.1.1.\u00a0<span style=\"text-decoration: underline;\">P\u0159\u00edstupy:<\/span>\u00a0Transtempor\u00e1ln\u00edm p\u0159\u00edstupem (tempor\u00e1ln\u00ed ok\u00e9nko p\u0159edn\u00ed, st\u0159edn\u00ed nebo zadn\u00ed) je vy\u0161et\u0159ov\u00e1na a. cerebri media (M1, M2), a. cerebri anterior (A1), a. cerebri posterior (P1, P2) a&nbsp;dist\u00e1ln\u00ed a. carotis interna. Transforamin\u00e1ln\u00edm (subokcipit\u00e1ln\u00edm) p\u0159\u00edstupem jsou vy\u0161et\u0159ov\u00e1ny dist\u00e1ln\u00ed \u00faseky vertebr\u00e1ln\u00edch tepen (V4) a&nbsp;basil\u00e1rn\u00ed kmen, eventueln\u011b moze\u010dkov\u00e9 tepny (nej\u010dast\u011bji PICA). Transorbit\u00e1ln\u00edm p\u0159\u00edstupem se vy\u0161et\u0159uje standardn\u011b karotick\u00fd sifon (C2, C3) a&nbsp;oftalmick\u00e1 tepna. Dopl\u0148kov\u011b lze pou\u017e\u00edt submandibul\u00e1rn\u00ed p\u0159\u00edstup k\u00a0vy\u0161et\u0159en\u00ed a. carotis interna. Z\u00e1kladn\u00edmi sou\u010d\u00e1stmi ka\u017ed\u00e9ho TCD vy\u0161et\u0159en\u00ed jsou transtempor\u00e1ln\u00ed insonace z\u00a0obou stran a&nbsp;transforamin\u00e1ln\u00ed p\u0159\u00edstup.<\/p>\n<p>5.1.2\u00a0\u00a0<span style=\"text-decoration: underline;\">Technika vy\u0161et\u0159en\u00ed:<\/span>\u00a0Poloha pacienta je vle\u017ee na z\u00e1dech pro p\u0159\u00edstup transtempor\u00e1ln\u00ed a&nbsp;transorbit\u00e1ln\u00ed, vle\u017ee na boku nebo vsed\u011b s\u00a0p\u0159edklon\u011bnou hlavou pro p\u0159\u00edstup transforamin\u00e1ln\u00ed. Pozice vy\u0161et\u0159uj\u00edc\u00edho je ze z\u00e1hlav\u00ed pacienta. Optimalizac\u00ed polohy sondy, velikosti a&nbsp;um\u00edst\u011bn\u00ed vzorkov\u00e9ho objemu, akustick\u00e9 intenzity (power), zisku (gain) a&nbsp;nastaven\u00ed rozsahu citlivosti zobrazen\u00ed je dosa\u017eeno z\u00e1znamu kvalitn\u00ed spektr\u00e1ln\u00ed k\u0159ivky, vhodn\u00e9 k\u00a0anal\u00fdze hemodynamick\u00fdch parametr\u016f. Sou\u010d\u00e1st\u00ed vy\u0161et\u0159en\u00ed je proveden\u00ed z\u00e1kladn\u00edho testu funk\u010dn\u00ed reaktivity (minim\u00e1ln\u011b na obou a. cerebri media a&nbsp;basil\u00e1rn\u00edm kmeni) metodou BH\/HV (zadr\u017een\u00ed dechu s\u00a0n\u00e1slednou hyperventilac\u00ed po&nbsp;dobu 30 s) ve v\u0161ech \u00fa\u010deln\u00fdch indikac\u00edch, pokud to umo\u017e\u0148uj\u00ed okolnosti vy\u0161et\u0159en\u00ed a&nbsp;pacient je schopen spolupr\u00e1ce. V\u00a0p\u0159\u00edpad\u011b monitoringu je po&nbsp;dosa\u017een\u00ed optim\u00e1ln\u00ed polohy sonda zpravidla upevn\u011bna s\u00a0pou\u017eit\u00edm fixa\u010dn\u00edho za\u0159\u00edzen\u00ed.<\/p>\n<p><span style=\"text-decoration: underline;\">5.1.3\u00a0 Anal\u00fdza z\u00e1znamu:<\/span>\u00a0V\u00fdsledkem vy\u0161et\u0159en\u00ed je z\u00e1znam spektr\u00e1ln\u00ed dopplerovsk\u00e9 k\u0159ivky (D \u2013 mode), p\u0159\u00edpadn\u011b nav\u00edc grafick\u00fd z\u00e1znam intenzity sign\u00e1lu v\u00a0hloubkov\u00e9m pr\u016f\u0159ezu (Power M \u2013 mode). Vyzna\u010den\u00e1 hloubka, pozice sondy a&nbsp;sm\u011br pr\u016ftoku umo\u017e\u0148uje identifikaci tepny. \u00dahel insonace nelze vizu\u00e1ln\u011b korigovat, dle konvence je pova\u017eov\u00e1n za 0 stup\u0148\u016f. Ze z\u00e1znamu se posuzuj\u00ed pr\u016ftokov\u00e9 rychlosti (Vs, Vd, Vmean), indexy pulzatility (PI) a&nbsp;rezistence (RI), charakter pr\u016ftoku (lamin\u00e1rn\u00ed, turbulentn\u00ed), eventueln\u011b dal\u0161\u00ed hemodynamick\u00e9 parametry. V\u00fdsledkem monitoring\u016f je vyhodnocen\u00ed po\u010dtu a&nbsp;charakteru sledovan\u00fdch jev\u016f (HITS) nebo hemodynamick\u00fdch zm\u011bn.<\/p>\n<p>5.1.4.\u00a0\u00a0<span style=\"text-decoration: underline;\">Z\u00e1pis do protokolu:<\/span>\u00a0V\u00fdstupem vy\u0161et\u0159en\u00ed mus\u00ed b\u00fdt protokol, kter\u00fd je pro dan\u00e9 pracovi\u0161t\u011b typizovan\u00fd a&nbsp;obsahuje identifika\u010dn\u00ed \u00fadaje o&nbsp;pracovi\u0161ti, pou\u017eit\u00e9m p\u0159\u00edstroji, datum a&nbsp;jm\u00e9no vy\u0161et\u0159uj\u00edc\u00edho, osobn\u00ed data pacienta, indika\u010dn\u00ed d\u016fvody vy\u0161et\u0159en\u00ed, z\u00e1znam numerick\u00fdch hodnot m\u011b\u0159en\u00ed (pr\u016ftokov\u00e9 rychlosti, z\u00e1kladn\u00ed indexy) ze v\u0161ech vy\u0161et\u0159en\u00fdch tepen a&nbsp;slovn\u00ed popis n\u00e1lezu se zhodnocen\u00edm. Obrazov\u00fd z\u00e1znam by m\u011bl b\u00fdt archivov\u00e1n v\u00a0p\u0159\u00edpad\u011b patologick\u00fdch n\u00e1lez\u016f. Jsou v\u017edy dokumentov\u00e1ny d\u016fvody nekompletn\u00edho vy\u0161et\u0159en\u00ed.<\/p>\n<p>5.2.\u00a0\u00a0<span style=\"text-decoration: underline;\">Standardn\u00ed postup vy\u0161et\u0159en\u00ed<\/span><\/p>\n<p>\u00dapln\u00e9 TCD vy\u0161et\u0159en\u00ed zahrnuje v\u0161echny standardn\u00ed \u010d\u00e1sti, z\u00edskan\u00e9 postupem dle bodu 5.1. Jeho sou\u010d\u00e1st\u00ed je pe\u010dliv\u00e9 vy\u0161et\u0159en\u00ed jednotliv\u00fdch tepen s\u00a0anal\u00fdzou hemodynamick\u00fdch zm\u011bn, z\u00e1znamem nam\u011b\u0159en\u00fdch hodnot do protokolu a&nbsp;slovn\u00edm popisem n\u00e1lezu.<\/p>\n<p><span style=\"text-decoration: underline;\">5.2.1.\u00a0 Postup vy\u0161et\u0159en\u00ed jednotliv\u00e9 tepny:<\/span>\u00a0Ka\u017ed\u00e1 c\u00e9va mus\u00ed b\u00fdt vy\u0161et\u0159ena v\u00a0r\u016fzn\u00fdch hloubk\u00e1ch v\u00a0cel\u00e9m\u00a0jej\u00edm insonovateln\u00e9m pr\u016fb\u011bhu, s\u00a0anal\u00fdzou sm\u011bru toku krve a&nbsp;spektr\u00e1ln\u00ed dopplerovsk\u00e9 k\u0159ivky.<\/p>\n<p>P\u0159i norm\u00e1ln\u00edm z\u00e1znamu jsou zaps\u00e1ny nejvy\u0161\u0161\u00ed nam\u011b\u0159en\u00e9 rychlosti. V\u00a0p\u0159\u00edpad\u011b zji\u0161t\u011bn\u00fdch patologick\u00fdch zm\u011bn mus\u00ed b\u00fdt proveden z\u00e1znam z\u00a0patologick\u00e9ho segmentu a&nbsp;z\u00a0oblasti proxim\u00e1ln\u011b i&nbsp;dist\u00e1ln\u011b od n\u011bj.<\/p>\n<p>5.2.2.\u00a0 \u00a0<span style=\"text-decoration: underline;\">Minim\u00e1ln\u00ed rozsah vy\u0161et\u0159en\u00ed:<\/span>\u00a0V\u00a0protokolu mus\u00ed b\u00fdt obsa\u017eeny minim\u00e1ln\u011b n\u00e1sleduj\u00edc\u00ed segmenty:<\/p>\n<p>A)\u00a0Arteria cerebri media<br \/>\nB)\u00a0Arteria cerebri anterior<br \/>\nC)\u00a0Arteria cerebri posterior<br \/>\nD)\u00a0Arteria carotis interna (intrakrani\u00e1ln\u00ed)<br \/>\nE)\u00a0Arteriae vertebrales dist.<br \/>\nF)\u00a0Arteria basilaris<\/p>\n<p>Nelze-li z\u00a0objektivn\u00edch d\u016fvod\u016f n\u011bkterou z\u00a0uveden\u00fdch tepen vy\u0161et\u0159it, mus\u00ed b\u00fdt v\u00a0protokolu tato skute\u010dnost uvedena. Pokud jsou zachyceny toky v\u00a0dal\u0161\u00edch tepn\u00e1ch (PICA, p\u0159edn\u00ed a&nbsp;zadn\u00ed komunikanty), m\u011bly by b\u00fdt rovn\u011b\u017e zaznamen\u00e1ny. Sou\u010d\u00e1st\u00ed z\u00e1znamu jsou i&nbsp;v\u00fdsledky proveden\u00fdch test\u016f funk\u010dn\u00ed reaktivity ve v\u0161ech \u00fa\u010deln\u00fdch p\u0159\u00edpadech. P\u00e1rov\u00e9 tepny jsou v\u017edy vy\u0161et\u0159eny oboustrann\u011b, protokol umo\u017e\u0148uje stranov\u00e9 porovn\u00e1n\u00ed pr\u016ftokov\u00fdch parametr\u016f.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">6. Indikace vy\u0161et\u0159en\u00ed<\/span><\/strong><\/p>\n<p>Z\u00e1kladn\u00edm d\u016fvodem indikac\u00ed TCD vy\u0161et\u0159en\u00ed je klinick\u00e1 symptomatologie pacienta, d\u00e1le pak n\u00e1lezy pomocn\u00fdch vy\u0161et\u0159en\u00ed (zobrazovac\u00edch i&nbsp;funk\u010dn\u00edch), kter\u00e9 mus\u00ed b\u00fdt komplexn\u011b posouzeny. P\u0159edpokladem pro spr\u00e1vnou interpretaci n\u00e1lezu TCD vy\u0161et\u0159en\u00ed je p\u0159edchoz\u00ed proveden\u00ed duplexn\u00ed sonografie extrakrani\u00e1ln\u00edch tepen, jej\u00ed\u017e v\u00fdsledek by m\u011bl m\u00edt vy\u0161et\u0159uj\u00edc\u00ed k\u00a0dispozici. N\u00e1sleduje p\u0159ehled nejd\u016fle\u017eit\u011bj\u0161\u00edch indikac\u00ed TCD vy\u0161et\u0159en\u00ed:<\/p>\n<p>6.1.\u00a0 Vy\u0161et\u0159en\u00ed pacient\u016f se sten\u00f3zami nebo okluzemi extrakrani\u00e1ln\u00edch tepen \u2013 zji\u0161t\u011bn\u00ed a&nbsp;sledov\u00e1n\u00ed d\u016fsledk\u016f pro mozkovou cirkulaci a&nbsp;kolater\u00e1ln\u00edho ob\u011bhu, vy\u0161et\u0159en\u00ed p\u0159ed pl\u00e1novan\u00fdm revaskulariza\u010dn\u00edm v\u00fdkonem.<\/p>\n<p>6.2.\u00a0 Vy\u0161et\u0159en\u00ed pacient\u016f s\u00a0podez\u0159en\u00edm na stenotick\u00fd proces intrakrani\u00e1ln\u00edch tepen (eventueln\u011b s\u00a0prok\u00e1zan\u00fdmi intrakrani\u00e1ln\u00edmi sten\u00f3zami) \u2013 zji\u0161t\u011bn\u00ed a&nbsp;sledov\u00e1n\u00ed intrakrani\u00e1ln\u00edch sten\u00f3z a&nbsp;jejich hemodynamick\u00fdch d\u016fsledk\u016f.<\/p>\n<p>6.3. Vy\u0161et\u0159en\u00ed pacient\u016f s\u00a0akutn\u00ed CMP ischemick\u00e9ho p\u016fvodu v\u00a0karotick\u00e9m i&nbsp;vertebrobazil\u00e1rn\u00edm povod\u00ed\u00a0\u00a0 nebo pacient\u016f po&nbsp;prod\u011blan\u00e9 tranzitorn\u00ed ischemick\u00e9 atace (TIA).<\/p>\n<p>6.4.\u00a0Vy\u0161et\u0159en\u00ed pacient\u016f s\u00a0chronick\u00fdm cerebrovaskul\u00e1rn\u00edm onemocn\u011bn\u00edm, v\u00a0diferenci\u00e1ln\u00ed diagnostice a&nbsp;sledov\u00e1n\u00ed intrakrani\u00e1ln\u00edch angiopati\u00ed.<\/p>\n<p>6.5.\u00a0Vy\u0161et\u0159en\u00ed pacient\u016f s\u00a0c\u00e9vn\u00edmi malformacemi, zejm\u00e9na s\u00a0arterioven\u00f3zn\u00edm zkratem \u2013 stanoven\u00ed z\u00e1sobuj\u00edc\u00edch c\u00e9v malformace, sledov\u00e1n\u00ed \u00fasp\u011b\u0161nosti terapeutick\u00fdch z\u00e1sah\u016f.<\/p>\n<p>6.6.\u00a0Vy\u0161et\u0159en\u00ed k\u00a0pr\u016fkazu a&nbsp;sledov\u00e1n\u00ed vazospazm\u016f, nej\u010dast\u011bji u&nbsp;pacient\u016f po&nbsp;subarachnoid\u00e1ln\u00edm krv\u00e1cen\u00ed.<\/p>\n<p>6.7.\u00a0Vy\u0161et\u0159en\u00ed ke stanoven\u00ed mozkov\u00e9 smrti.<\/p>\n<p>6.8.\u00a0Vy\u0161et\u0159en\u00ed pacient\u016f s\u00a0kraniocerebr\u00e1ln\u00edmi traumaty a&nbsp;rozs\u00e1hl\u00fdmi l\u00e9zemi mozku, sledov\u00e1n\u00ed v\u00a0r\u00e1mci komplexn\u00edho monitoringu zv\u00fd\u0161en\u00e9ho intrakrani\u00e1ln\u00edho tlaku.<\/p>\n<p>6.9.\u00a0Vy\u0161et\u0159en\u00ed v\u00a0diferenci\u00e1ln\u00ed diagnostice bolest\u00ed hlavy, zejm\u00e9na migr\u00e9ny.<\/p>\n<p>6.10. Detekce pravolev\u00e9ho zkratu p\u0159i&nbsp;podez\u0159en\u00ed na epizody paradoxn\u00ed embolizace.<\/p>\n<p>6.11. Specieln\u00ed indikace TCD monitoring\u016f:<\/p>\n<p>6.11.1. Peropera\u010dn\u00ed monitorov\u00e1n\u00ed karotick\u00e9 endarterektomie, angioplastiky a&nbsp;stentov\u00e1n\u00ed extra a&nbsp;intrakrani\u00e1ln\u00edch tepen, eventueln\u011b jin\u00e9ho kardiovaskul\u00e1rn\u00edho\u00a0 v\u00fdkonu, v\u010detn\u011b poopera\u010dn\u00edho sledov\u00e1n\u00ed.<\/p>\n<p>6.11.2. Detekce mikroembolizac\u00ed do\u00a0intrakrani\u00e1ln\u00ed oblasti s\u00a0c\u00edlem vyhodnocen\u00ed rizika a&nbsp;stanoven\u00ed zdroje.<\/p>\n<p>6.12. P\u0159\u00edm\u00fd peropera\u010dn\u00ed mikrovaskul\u00e1rn\u00ed monitoring p\u0159i&nbsp;neurochirurgick\u00fdch operac\u00edch (vaskul\u00e1rn\u00ed anastom\u00f3zy, operace AV malformac\u00ed a&nbsp;aneurysmat).<\/p>\n<p><strong><span style=\"text-decoration: underline;\">7. Hodnocen\u00ed n\u00e1lezu, diagnostick\u00e1 kriteria<\/span><\/strong><\/p>\n<p>C\u00edlem TCD vy\u0161et\u0159en\u00ed je identifikace a&nbsp;zhodnocen\u00ed patologick\u00fdch zm\u011bn v\u00a0intrakrani\u00e1ln\u00ed cirkulaci a&nbsp;dokumentov\u00e1n\u00ed jejich p\u016fvodu, lokalizace a&nbsp;t\u00ed\u017ee. Obecn\u011b toto hodnocen\u00ed vych\u00e1z\u00ed z\u00a0lok\u00e1ln\u00edch zm\u011bn rychlosti, sm\u011bru a&nbsp;charakteristiky toku krve.\u00a0 Dal\u0161\u00ed parametry dopplerovsk\u00e9 k\u0159ivky, p\u0159\u00edtomnost abnorm\u00e1ln\u00edch sign\u00e1l\u016f a&nbsp;v\u00fdsledky test\u016f funk\u010dn\u00ed reaktivity mohou dopom\u00e1hat ke spr\u00e1vn\u00e9 interpretaci n\u00e1lezu. Z\u00e1kladn\u00ed kriteria, zahrnuj\u00edc\u00ed parametry fyziologick\u00e9ho n\u00e1lezu a&nbsp;nej\u010dast\u011bj\u0161\u00ed patologick\u00e9 zm\u011bny, jsou obsa\u017eena v\u00a0<strong>odborn\u00e9 p\u0159\u00edloze standardu<\/strong>. Jedn\u00e1 se o&nbsp;doporu\u010den\u00ed, zalo\u017een\u00e1 na publikovan\u00fdch \u00fadaj\u00edch a&nbsp;vlastn\u00edch zku\u0161enostech autor\u016f standardu a&nbsp;pro pravideln\u00e9 vyu\u017e\u00edv\u00e1n\u00ed doporu\u010dujeme v\u017edy jejich vnit\u0159n\u00ed validaci na individu\u00e1ln\u00edm sonografick\u00e9m pracovi\u0161ti.<\/p>\n<p><strong>Dokument ke sta\u017een\u00ed:\u00a0<a href=\"https:\/\/www.czech-neuro.cz\/archiv\/data\/h\/7\/t\/phph7tpL2.doc\" target=\"_blank\" rel=\"noopener\">Sonografie<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Transkrani\u00e1ln\u00ed dopplerovsk\u00e1 sonografie \u2013 n\u00e1rodn\u00ed standard vy\u0161et\u0159en\u00ed v\u00a0r\u00e1mci funk\u010dn\u00ed specializace v&nbsp;neurosonologii \u0160koda O., Mikul\u00edk R.., \u0160koloud\u00edk D. Neurosonologick\u00e1 komise cerebrovaskul\u00e1rn\u00ed&#8230;<\/p>\n","protected":false},"author":23,"featured_media":0,"parent":3047,"menu_order":170,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","kia_subtitle":"","footnotes":""},"class_list":["post-3115","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.2 (Yoast SEO v26.2) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Transcranial Doppler sonography - \u010cesk\u00e1 neurologick\u00e1 spole\u010dnost<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Transcranial Doppler sonography\" \/>\n<meta property=\"og:description\" content=\"Transkrani\u00e1ln\u00ed dopplerovsk\u00e1 sonografie \u2013 n\u00e1rodn\u00ed standard vy\u0161et\u0159en\u00ed v\u00a0r\u00e1mci funk\u010dn\u00ed specializace v&nbsp;neurosonologii \u0160koda O., Mikul\u00edk R.., \u0160koloud\u00edk D. Neurosonologick\u00e1 komise cerebrovaskul\u00e1rn\u00ed...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/\" \/>\n<meta property=\"og:site_name\" content=\"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost\" \/>\n<meta property=\"article:modified_time\" content=\"2017-12-14T14:43:03+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Odhadovan\u00e1 doba \u010dten\u00ed\" \/>\n\t<meta name=\"twitter:data1\" content=\"12 minut\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/\",\"url\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/\",\"name\":\"Transcranial Doppler sonography - \u010cesk\u00e1 neurologick\u00e1 spole\u010dnost\",\"isPartOf\":{\"@id\":\"https:\/\/www.czech-neuro.cz\/#website\"},\"datePublished\":\"2017-12-14T13:42:08+00:00\",\"dateModified\":\"2017-12-14T14:43:03+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/#breadcrumb\"},\"inLanguage\":\"cs\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Dom\u016f\",\"item\":\"https:\/\/www.czech-neuro.cz\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Recommended practices\",\"item\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Recommended practices\",\"item\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Recommendations for general practitioners\",\"item\":\"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Transcranial Doppler sonography\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.czech-neuro.cz\/#website\",\"url\":\"https:\/\/www.czech-neuro.cz\/\",\"name\":\"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost\",\"description\":\"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost je odborn\u00e1 v\u011bdeck\u00e1 spole\u010dnost, jej\u00edm\u017e c\u00edlem je db\u00e1t o rozvoj neurologie jako v\u00fdznamn\u00e9 l\u00e9ka\u0159sk\u00e9 a v\u011bdeck\u00e9 discipliny v \u010cesk\u00e9 republice.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.czech-neuro.cz\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"cs\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Transcranial Doppler sonography - \u010cesk\u00e1 neurologick\u00e1 spole\u010dnost","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/","og_locale":"cs_CZ","og_type":"article","og_title":"Transcranial Doppler sonography","og_description":"Transkrani\u00e1ln\u00ed dopplerovsk\u00e1 sonografie \u2013 n\u00e1rodn\u00ed standard vy\u0161et\u0159en\u00ed v\u00a0r\u00e1mci funk\u010dn\u00ed specializace v&nbsp;neurosonologii \u0160koda O., Mikul\u00edk R.., \u0160koloud\u00edk D. Neurosonologick\u00e1 komise cerebrovaskul\u00e1rn\u00ed...","og_url":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/","og_site_name":"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost","article_modified_time":"2017-12-14T14:43:03+00:00","twitter_card":"summary_large_image","twitter_misc":{"Odhadovan\u00e1 doba \u010dten\u00ed":"12 minut"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/","url":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/","name":"Transcranial Doppler sonography - \u010cesk\u00e1 neurologick\u00e1 spole\u010dnost","isPartOf":{"@id":"https:\/\/www.czech-neuro.cz\/#website"},"datePublished":"2017-12-14T13:42:08+00:00","dateModified":"2017-12-14T14:43:03+00:00","breadcrumb":{"@id":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/#breadcrumb"},"inLanguage":"cs","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/sonography\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Dom\u016f","item":"https:\/\/www.czech-neuro.cz\/"},{"@type":"ListItem","position":2,"name":"Recommended practices","item":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/"},{"@type":"ListItem","position":3,"name":"Recommended practices","item":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/"},{"@type":"ListItem","position":4,"name":"Recommendations for general practitioners","item":"https:\/\/www.czech-neuro.cz\/en\/pro-odborniky\/recommended-practices\/doporuceni-pro-prakticke-lekare\/"},{"@type":"ListItem","position":5,"name":"Transcranial Doppler sonography"}]},{"@type":"WebSite","@id":"https:\/\/www.czech-neuro.cz\/#website","url":"https:\/\/www.czech-neuro.cz\/","name":"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost","description":"\u010cesk\u00e1 neurologick\u00e1 spole\u010dnost je odborn\u00e1 v\u011bdeck\u00e1 spole\u010dnost, jej\u00edm\u017e c\u00edlem je db\u00e1t o rozvoj neurologie jako v\u00fdznamn\u00e9 l\u00e9ka\u0159sk\u00e9 a v\u011bdeck\u00e9 discipliny v \u010cesk\u00e9 republice.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.czech-neuro.cz\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"cs"}]}},"lang":"en","translations":{"en":3115},"_links":{"self":[{"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/pages\/3115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/comments?post=3115"}],"version-history":[{"count":3,"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/pages\/3115\/revisions"}],"predecessor-version":[{"id":3152,"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/pages\/3115\/revisions\/3152"}],"up":[{"embeddable":true,"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/pages\/3047"}],"wp:attachment":[{"href":"https:\/\/www.czech-neuro.cz\/api\/wp\/v2\/media?parent=3115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}